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i i i i i i i i i i i i l i i i i tfi tfi <br /> Advanced CHAIN OF CUSTODY ECORD <br /> _ Date Z Page <br /> tt / of <br /> GeoEnvironmental, Inc. p�3 Zp��.�} <br /> 837 Shaw Road-Stocklon,California-95215-(209)467-1006- Fax (209)467-1118 1 j q ! <br /> Client Project Manager <br /> .- Tests Required <br /> Phone Number <br /> s -- <br /> ti <br /> Samplers (Signature) Invoice <br /> {. 9 AGE <br /> Project Name /�• / _ P yt� Client [� <br /> Sample Type V <br /> Sample Location /00rDate Time Water I Solid No of Notes <br /> Number Description Comp Grab Air Conts <br /> I <br /> OF <br /> aZ 3 Ile) <br /> p zjd /�`irS <br /> A/o"7 <br /> Relin ui y r nature aea ve gn to 3�i QatslTime <br /> elin ed by (Signal ) Vaftlelved by (Signature) Date tms <br /> Relinquished By (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> i <br /> Dispatched by (Signature) Date/Time Received for Laboratory by DatelTims <br /> Method of Shipment Laboratory Name <br /> �!a C <br /> Spacial Instructions I hereby aul ize the performance f the above indicated work <br /> t3 �� <br />